KARMA BUMPS REGISTRATION & HEALTH WAIVER FORM

FOR ANTE/PRENATAL YOGA WITH MINA

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CONTACT DETAILS

EMERGENCY CONTACT

MEDICAL DETAILS

During this pregnancy, have you experienced any of the following? 

Morning  Sickness 

Constipation

Nosebleeds

Lower Back Pain

Varicose Veins

High Blood Pressure

Depression

Bleeding

Headaches

Anaemia

Sciatica

Oedema ( Swollen joints)

Pre- Eclampsia

Anxiety

Fibroid Pain

Dizziness

Breathlessness

Diabetes

Aching Groin

Sleep Disturbance

Low lying Placenta

Pelvic Girdle Pain

Other, Please give details

Please give details of any of the above which you have selected, or any other health issues which you feel may have some bearing on your yoga practice.

Are you currently taking medications or has serious allergies that should be made known to medical personnel in case of an emergency, please indicate them here:

Please note aromatherapy and pure essential oils may be used in some of the yoga classes.

If allergic to essential oils, please advise before each class.

Prior to this pregnancy, have you suffered any injury or undergone any surgery (e.g caesarean birth, knee surgery )

that may have some bearings on your yoga practice?

If so, please give details below.

If applicable would you like to share any information on previous

pregnancies or miscarriages that may have some bearings on your yoga practice? 

If so, please give details below

Are there any reasons why GP approval may be required before you can participate in the class

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If YES to the above question

Any extra help we need to provide (for example because of a disability):

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If YES to the above question please let us know how we can help below

Is there any other information you feel you need to share prior to your first yoga class? How did you hear about Ministry of Yoga Prenatal Yoga Classes with Mina?

PREVIOUS YOGA EXPERIENCE

Have you practiced yoga before? 

If Yes

Please give details of how long, what style of yoga? Why have you come to yoga, and what do you hope to gain from it? 

How did you hear about Ministry of Yoga Prenatal Yoga Classes with Mina?

DISCLAIMER

Please acknowledge the following disclaimer: 

• I have declared all information regarding my health and the health of the baby that might affect my successful participation in the Pregnancy Yoga classes. 

• I take full responsibility for my body and my baby. 

• If I have any worries, I will seek the advice of my medical professional 

before proceeding with Jasmin Colangelo’s Pregnancy Yoga classes. 

• I will promptly inform my teacher Mina Bhama of any health issues that arise during the course of my pregnancy. 

In further consideration of permitting myself to participate in the yoga class,

I knowingly, voluntarily, and expressly waive any claim I may have against Karma Kids Uk Ltd, Jade Lawrence and Mina Bhama or any other teacher working for Karma Kids Yoga UK and the owner/lessor of the Premises for injury or damages that I  may sustain while on the Premises as a result of participating in the yoga class.

   

I, my heirs or legal representatives irrevocably covenant not to sue and forever release, waive, and discharge any other claims of any kind whatsoever against Karma Kids Uk Ltd, Jade Lawrence & Mina Bhama or any other teacher working for Karma Kids Yoga UK Ltd or the owner/lessor of the Premises for any personal injury, property loss or damage, or wrongful death, whether caused by negligence or otherwise.

I have read the above release and waiver of liability and fully understand its contents.

I acknowledge this disclaimer, I voluntarily agree to the terms and conditions,  stated  & confirm that that the details I have provided are correct

by ticking the box below 

​I agree to 

Karma Kids UK LTD/Mina Bhama keeping a record of this form for health and safety reasons under our GDPR & Privacy guidelines

covid safety

Karma Kids aims to provide a safe and enjoyable experience

To help us do this, please note the following important information 

  • You should arrive at the studio at the class time, using any one way system set in place by the Ministry of Yoga.

  • We cannot accept any loss, responsibility or damage to any personal belongings

  • Please ensure you follow social distancing in accordance with Gov guidance whilst in the main areas of the Ministry of Yoga

  • Masks should be worn on the premises 

  • Please check in using the Covid QR code

  • Equipment will be kept to a minimum & will not be shared between participants/classes

  • All equipment & the Karma Kids Uk Ltd studio will be cleaned between classes

  • To avoid Covid transmission you have the option of bringing/providing your  own yoga mat

  • No food is to be consumed within the yoga studio. *

  • Only water in closed containers (no glasses or cups) is to be drunk within the yoga studtios. *

  • No hot drinks are allowed.*

  • In the event of a fire, visitors are asked to make their way to the nearest available exit.

We reserve the right to cancel a course if there is a problem with the class size. In the event of cancellation, your course fee will be returned and will endeavour to offer you an opportunity to attend another course. If  you wish to cancel your place before the course starts, you must give 14 days’ notice before the start date. 

For more information please click here for our General Terms & Conditions 

Thank you for taking the time to register for

Karma Bumps Pregnancy yoga classes

with Mina Bhama

Thanks for submitting!